Abrasive esophageal cytology for the oncological follow-up of patients with head and neck cancer

Objectives: The occurrence of a second primary cancer in the esophagus in p atients with head and neck squamous cell carcinoma is frequent and is assoc iated with a poor prognosis, The aim of this study was to evaluate the yiel d of abrasive esophageal cytology as a means of screening for metachronous cancer of the upper aerodigestive tract. Study Design: We retrospectively r eviewed the results of abrasive esophageal cytology performed twice yearly for the screening of patients with prior head and neck cancer. Methods: Fro m 1987 to 1996, 320 patients treated for head and neck cancer underwent 1,6 73 abrasive cytology examinations of the esophagus during a mean follow-up period of 4 years. Cytological results were classified as negative, suspect , or positive for malignancy. Results: Twenty-five patients without symptom s had one or more suspect or positive cytologic findings, leading to 29 end oscopic examinations. These revealed 20 premalignant or early malignant les ions of the esophagus (2 dysplasias, 18 squamous cell carcinomas), 2 glandu lar carcinomas, and 10 clinically unsuspected oral or pharyngeal carcinomas . In seven patients, positive cytological results were associated with clin ically visible head and neck cancer, Of the 34 patients with suspect cytolo gical results for malignancy, 10 had no evidence of tumor at endoscopy and 24 had no endoscopic examination because of refusal or because suspected ce lls were not found in additional examinations. Negative results on cytologi cal examination were found for 254 patients throughout their follow-up, and none of them developed esophageal cancer during a mean follow-up period of 3 years. Conclusions: For patients with head and neck cancer, abrasive spo nge cytology is useful for detecting esophageal cancer at an early stage. I n addition, it may reveal unsuspected second primaries or recurrences in th e head and neck region.